Emotion suppression and the Cardiovascular Conundrum: Hemodynamic responses to Minority Stress in LGB individuals

The “Cardiovascular Conundrum” describes a paradoxical autonomic pattern in which increased total peripheral resistance (TPR) co-occurs with elevated vagally mediated heart rate variability (HRV), resulting in a predominantly vascular and potentially maladaptive hemodynamic profile. This configuration has been documented in African American individuals and attributed to genetic factors or prolonged exposure to discrimination and emotional suppression. The present study examined whether a similar pattern emerges in another minoritized population: lesbian, gay, bisexual (LGB) individuals. 44 LGB and 46 heterosexual participants, matched for age and sex, were assessed at rest and during the recall of a personal discriminatory event. Cardiovascular activity was continuously recorded. At baseline, LGB participants exhibited the same paradoxical autonomic profile reported in African American individuals, with higher TPR (d=.36) and HRV (d=.31) and a more vascular hemodynamic pattern characterized by increased TPR and reduced cardiac output (CO) (d=.40). Participants were then randomly assigned to a 10-minute emotional suppression condition or to a free-recovery condition. Across conditions, heterosexual participants displayed a myocardial response profile, indexed by higher CO (F = 4.59; η² = .05). In contrast, under free recovery, LGB individuals showed a vascular response characterized by a significantly higher TPR (d=.73). When emotional suppression was experimentally induced, this group difference was no longer evident, as heterosexual participants shifted toward a vascular profile like the LGB group. These findings highlight the role of emotional suppression in the Cardiovascular Conundrum and support the biological embedding of minority stress in sexual minority individuals, underscoring the need for targeted interventions.